| 1. |
- Amani, Paul Joseph, 1975-
(författare)
-
Does health insurance contribute to improving responsiveness of the health system? : the case of elderly in rural Tanzania
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Financing healthcare in Tanzania has for years depended on out-of-pocket payments. This mechanism has been criticized as being inefficient, contributing to inequity and high cost as well as denying access to healthcare to those most in need, including the elderly in rural areas. Health insurance (HI) was recently introduced as an instrument to enable equitable access to healthcare and thus to improve the responsiveness of the health system. Even though health insurance is expected to bring benefits to those who are insured, there is a lack of specific studies in the country looking at the role of HI in facilitating the health system responsiveness among vulnerable populations of remote areas.Aim: The aim of this thesis is to understand if and how health insurance contributes to improving the responsiveness of the healthcare system among the elderly in rural Tanzania. Methods: Four interrelated sub-studies (2 quantitative and 2 qualitative) were conducted in Igunga and Nzega districts of Tabora region between July 2017 and December 2018. The first two sub-studies are based on a household survey using an adapted version of the World Health Organization’s Study on Global Ageing and Adult Health questionnaire. Elderly people aged 60 years and above who had used both outpatient and inpatient healthcare three and twelve months prior to the study, respectively, were interviewed. Whereas in sub-study 1 the focus was to investigate the role of health insurance status on facilitating access to healthcare, sub-study 2 assessed the relationship between health insurance and the health system responsiveness domains. In sub-study 3, interviews with healthcare providers were carried out to capture their perspective regarding the functioning of the health insurance. In the final sub-study 4, focus group discussions with elderly were conducted in order to explore their experience of healthcare, depending on their health insurance status. Crude and adjusted logistic and quantile regression models were applied to analyse the association between health insurance and access to healthcare (sub-study 1) and responsiveness (sub-study 2), respectively. For both sub-studies 3 and 4, qualitative content analysis was used to analyse the data.Results: Sub-studies 1 and 2 involved a total of 1899 insured and uninsured elderly, while sub-studies 3 and 4 included 8 health providers and 78 elderlies respectively. Sub-study 1 showed that about 45% of the elderly were insured and HI ownership improved access and utilization of healthcare, both outpatient and inpatient services. In sub-study two, however, health insurance was associated with a lower responsiveness of the healthcare system. In general, all six domains: cleanliness, access, confidentiality, autonomy, communication, and prompt attention were rated high, but three were of concern: waiting time; cleanliness; and communication. Sub-study 3 uncovered several challenges coexisting alongside the provision of insurance benefits and thus contributing to a lower responsiveness. These included shortage of human resources and medical supplies, as well as operational issues related to delays in funding reimbursement. In sub-study 4, the elderly revealed that HI did not meet their expectations, it failed to promote equitable access, provided limited-service benefits and restricted use of services within residential areas. Conclusion: While HI seems to increase the access to and use of healthcare services by the elderly in rural Tanzania, a lower responsiveness by the healthcare system among the insured elderly was reported. Long waiting times, limited-service benefits, restricted use of services within schemes, lack of health workforce in both numbers and skills as well as shortage of medical supplies were important explanations for the lower responsiveness. The results of this thesis, while supporting the national aim of expanding HI in rural areas, also exposed several weaknesses that require immediate attention. There is a need to, first, review the insurance policy to improve its implementation, expand the scope of services coverage, and where possible, to introduce cross-subsidization between the publicly owned schemes; additionally, improvements in the healthcare infrastructure, increasing the number of qualified health workforce and the availability of essential medicines and laboratory services, especially at the primary healthcare facilities, should be prioritized and further investments allocated.
|
|
| 2. |
- Emsing, Mikael, 1980-
(författare)
-
Conflict management & mental health among Swedish police officers & recruits
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An essential part of police work is handling people in distress, often related to some form of conflict that police officers are expected to handle in a professional manner. Thus, interpersonal and conflict management skills are essential for police officers. Further, police work has been hailed as one of the most complex and stressful jobs that one can have. While important progress has been made in relation to how the complex and stressful nature of police work affects the individual officers - less is known about the timing and onset of these effects. Similarly, while there is a growing body of research into police conflict management, more research is needed to deepen our understanding of police conflict management, not least in the Swedish context. The overall aim of the present thesis was to contribute to existing knowledge about police work by investigating conflict management and mental health among Swedish police recruits and officers.Materials and methods: The present thesis used a mixed-methods approach and is built on four sub-studies. Sub-study 1 examined the evidence base for current practices, methods, and training in conflict management by means of a scoping review. Sub-study 2 used semi-structured interviews to examine how police officers perceived conflict and conflict-management and their training within the subject. Results from sub-study 2 where also used increating items for the instrument developed in sub-study 4. Sub-study 3 used a quantitative design to examine the mental health status of Swedish police recruits using the SCL-90 questionnaire. Sub-study 4 documented the initial steps towards developing an instrument to measure conflict behaviors and attitudes to conflict management among police officers and evaluated the psychometric properties of this instrument.Results: A large proportion of the studies included in the scoping review were conducted in the US and manyfocused-on use of force. The results also indicate that a lack of available data, unified definitions and experimental as well as longitudinal research designs makes it difficult to draw causal conclusions regarding the effectiveness of training in conflict management. In the interviews, respondents described conflict largely in terms of interpersonal conflicts, and focused less on intrapersonal conflict. The complexity and importance of the role played by instructors during probationary training was also salient in their descriptions. As for mental health status, recruits overall reported scores that where similar to the general population. A small number of recruits (n = 15) reported scores that where above the patient mean of the Swedish general population in the corresponding age group. The intended factor structure of the instrument developed could not be operationalized in the instruments current form, but the instrument could still provide insights and provides a basis for further development of the instrument.Conclusions: To enhance our understanding on police conflict management, scholars and police departments should work together to agree upon unified definitions on key concepts related to this topic. More research using longitudinal and experimental designs are needed to further develop training interventions related to conflict management. While a small number of recruits reported scores above the Swedish patient mean, extant research has indicated that stigmas surrounding mental health among police could lead to unconstructive coping behaviors. Further research on mental health among not only Swedish police officers but also recruits, could focus on helpseeking-behaviors and stigmas related to mental health to provide valuable insights on the topic. The instrument developed within the present thesis needs further development but nonetheless represents a first step towards examining individual differences in relation to police conflict management behaviors and attitudes towards conflict.
|
|
| 3. |
- Eid Rodríguez, Daniel V., 1980-
(författare)
-
The rough journey to access health care : the case of leishmaniasis in the Bolivian rainforest
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Leishmaniasis is a parasitic infectious disease transmitted by vectors that cause three main clinical syndromes: cutaneous (CL), mucosal (ML), and visceral (VL). Since VL is not relevant to this thesis, only CL and ML will be further discussed. Leishmaniasis is present in 98 countries, with more than 350 million people at risk of infection. Leishmaniasis disproportionately affects poor countries and, in particular, remote areas where health services are weaker. Bolivia, a lower-middle-income country, is the fifth country with more cases in Latin America, and case detection and management is the main control strategy of the National Leishmaniasis Control Programme (NLCP). The NLCP provides free treatment to patients, which consists of systemic pentavalent antimonials (SPA) for 20 days. This treatment is highly toxic for patients and costly for the government, resulting in long periods of shortage of the drug. A good alternative to SPA is the use of intralesional pentavalent antimonials (ILPA), which are safer and have similar efficacy to SPA in treating CL. Case detection and management depend on a well-structured health-care system, and the primary level of care is responsible for this task in Bolivian endemic areas. It is well known that health-care access for leishmaniasis patients is limited but the extent and the determinant factors of this problem are unknown. The aim of this thesis is to assess health-care access among patients with leishmaniasis in a Bolivian rainforest rural area, addressing four specific questions: Who is most vulnerable to CL?; What is the extent of their lack of access to health care?; How do the dimensions of access and the quality of care influence health-care utilization in a context of vulnerability?; and how can a change in NLCP policy related to the treatment of CL improve the level of access to health care?Methods: This thesis is based on four studies that use quantitative and qualitative methods. Data collection was conducted through surveys, in-depth interviews and revision of official documents. Sub-study 1 was based on a cross-sectional study conducted in two communities of Cochabamba and assessed risk factors for CL using multivariate analysis. Sub-study 2 used the method of capture−recapture to assess the level of under-reporting of the national register for the period of 2013−2014, using Chapman’s formula. Sub-study 3 was conducted through in-depth interviews applied to 14 participants, using thematic analysis. Sub-study 4 was an economic evaluation that used data from surveys with physicians, official documents and key informants and compared the costs of systemic pentavalent antimonials (SPA) and intralesional pentavalent antimonials (ILPA) from the perspective of the Ministry of Health (MoH) and society. Additionally, a budget impact analysis of the implementation of ILPA in hypothetical scenarios of increasing level of demand was carried out.Main findings: Sub-study 1 showed that gender/sex was the only statistically significant factor associated with CL, with men being the most affected group. Other classical factors, such as animal ownership, house materials and protective measures were, however, not related to CL. Sub-study 2 revealed a high level of under-reporting (73%) of CL in the study area, and this under-reporting was higher among men compared to women. Sub-study 3 showed that the lack of availability, accessibility, affordability and quality of care were the main factors that limited the access to care of CL and ML patients. In sub-study 4, the economic analysis pointed out that the use of ILPA was cost-saving for the MoH and society, and the budget analysis confirmed that the implementation of ILPA as first-line treatment was not only cost-saving for the MoH, but it would also increase the number of patients accessing the treatment.Conclusions: The predominance of a sylvatic pattern of transmission, with men as the most affected group, demands new approaches to prevention related to occupational activities. The NLCP policy related to case management has been essential to reducing economic barriers for patients with leishmaniasis; however, there are still a considerable amount of cases who do not have access to the treatment. Lacko f health services, equipment and drugs, as well as difficulties in reaching health services, the high costs of seeking health care and the low quality of care are important factors that must be addressed to fulfil the right to health care for these patients. Finally, new therapeutic alternatives, such as ILPA, must be considered to reduce problems of affordability, adherence, as well as side effects to the treatment. This information can be used to develop targeted interventions aimed at increasing the access to health care of people with leishmaniasis in the rainforest of Bolivia.
|
|
| 4. |
- Gangane, Nitin, 1961-
(författare)
-
Breast cancer in rural India : knowledge, attitudes, practices; delays to care and quality of life
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cancer is a major public health problem globally. The incidence of cancer is increasing rapidly in many low- and middle-income countries like India due to the epidemiological transition. At present, breast cancer is the leading cancer in females in many countries including India. In spite of all of the epidemiological evidence pointing towards a surge in breast cancer cases, the National Cancer Control Programme of India has not yet taken sufficient measures to understand the disease burden and to plan a course of action to cope with the increasing cancer burden. Aim: The aim of this thesis is to explore the knowledge, attitudes, and practices regarding breast cancer in a predominantly rural district of central India along with identifying the determinants of delays to care and quality of life (QoL) in breast cancer patients. This understanding may help to strengthen the health system by improving breast cancer control and management programmes and the delivery of care.Methods: This thesis combines findings from two cross-sectional studies in the predominantly rural district of Wardha. The first study was a population-based crosssectional survey conducted on 1000 women, in which face-to-face interviews were conducted with the help of a questionnaire covering demographic and socio-economic information, knowledge, attitudes and practices regarding breast cancer screening and breast cancer. The Chi-square test for proportions and t-test for means were used and multivariable linear regression analysis was performed to study the association between socio-demographic factors and knowledge, attitude and practices. The second study was a patient-based cross-sectional study conducted in 212 breast cancer patients. All 212 breast cancer patients were included for patient delay. However, 208 female breast cancer patients could be included for system delay, quality of life and self-efficacy, as there was some information lacking in 4 patients. Information on socio-demographic characteristics, patient and system delays and also reasons for the delays were collected. The study also utilised WHOQOL–BREF for QoL and selfefficacy measurements in breast cancer patients. Socio-demographic determinants were examined by frequencies and means and multivariable logistic and linear regression analysis to assess the relationship between exposure and outcome variables.Results: One third of the respondents had not heard about breast cancer, and more than 90% of women from both rural and semi-urban areas were not aware of breast self-examination. Patient delay of more than 3 months was observed in almost half of participants, while a system delay of more than 12 weeks was seen in 23% of the breast cancer patients. The late clinical stage of the disease was also significantly associated with patient delay. The most common reason for patient delay was painlessness of the breast lump. Incorrect initial diagnosis or late reference for diagnosis were the most common reasons for diagnostic delay while the high cost of treatment was the most common reason for treatment delay. Self-efficacy was positively associated with QoL, after adjusting for socio-demographic factors, patient delay and clinical stage of disease.Conclusions: Our research showed poor awareness and knowledge about breast cancer, its symptoms and risk factors in women in rural India. Breast self-examination was hardly practiced, although the willingness to learn was high. Although The ideal is to have no delay in diagnosis and treatment, diagnostic and treatment delays observed in the study were not much higher than those reported in the literature, even from countries with good health facilities. However, further research is needed to identify access barriers throughout the process of cancer diagnosis and treatment. The quality of life was moderately good and its strong relationship with self-efficacy makes these two dimensions of breast cancer patients relevant enough to be considered for health workers and policy makers in the future.Interventions focused on improving breast awareness in women and the breast cancer continuum of care should be implemented at a district level. The role of community social health activists in breast cancer prevention should be encouraged and the implementation of an operational national breast cancer program is urgently required.
|
|
| 5. |
- Mumba Zulu, Joseph, 1980-
(författare)
-
Integration of national community-based health worker programmes in health systems : Lessons learned from Zambia and other low and middle income countries
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: To address the huge human resources for health (HRH) crisis that Zambia and other low and middle income countries (LMICs) are experiencing, most LMICs have engaged the services of small scale community-based health worker (CBHW) programmes. However, several challenges affect the CBHWs’ ability to deliver services. Integration of national CBHW programmes into health systems is an emerging innovative strategy for addressing the challenges. Integration is important because it facilitates recognition of CBHWs in the national primary health care system. However, the integration process has not been optimal, and a more comprehensive understanding of the factors that shape the integration process is lacking. This study aimed at addressing this gap by analysing the integration process of national CBHW programmes in health systems in LMICs, with a special emphasis on Zambia.Methodology: This was a qualitative study that used case study and systematic review study designs. The case study focused on Zambia and analysed the integration processes of Community Health Assistants (CHAs) into the health system at district level (Papers I-III). Data collected using key informant interviews, participant observation, in-depth interviews and focus group discussions were analysed using thematic analysis. The systematic review analysed, using thematic and pathways analysis, the integration process of national CBHWs into health systems in LMICs (Brazil, Ethiopia, India and Pakistan)-(Paper IV). The framework on the integration of health innovations into health systems guided the overall analysis.Results: Factors that facilitated the integration of CHAs into the health system in Zambia included the HRH crisis which triggered the willingness by the Ministry of Health to develop and support implementation of the integration strategy-the CHA strategy. In addition, the attributes of the CHA strategy, such as the perceived competence of CHAs compared to other CBHWs, enhanced the community’s confidence in the CHA services. Involvement of the community in selecting CHAs also increased the community’s sense of programme ownership. However, health system characteristics such as limited support by some support staff, supply shortages as well as limited integration of CHAs into the district governance system affected CHAs’ ability to deliver services. In other LMICs, as in Zambia, the HRH problems necessitated the development of integration strategies. In addition, the perceived relative advantage of national CBHWs with regard to delivering health services compared to the other CBHWs also facilitated the integration process. Furthermore, the involvement of community members and some politicians in programme processes enhanced the perceived legitimacy, credibility and relevance of programmes in other LMICs. Finally, the integration process within the existing health systems enhanced programme compatibility with health system elements such as financing. However, a rapid scale-up process, resistance from other health workers, ineffective incentive structures, and discrimination of CBHWs based on social, gender and economic status inhibited the integration process of national CBHWs into the health systems.Conclusion: Strengthening the integration process requires fully integrating the programme into the district health governance system; being aware of the factors that can influence the integration process such as incentives, supplies and communication systems; clear definition of tasks and work relationships; and adopting a stepwise approach to integration process.
|
|
| 6. |
- Njozing, Barnabas N, 1974-
(författare)
-
Bridging the Gap : implementing tuberculosis and HIV/AIDS collaborative activities in the Northwest Region of Cameroon
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV. Methods The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration. Results The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials Conclusion TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal.
|
|
| 7. |
- Rostami, Arian, 1973-
(författare)
-
Police officers under pressure : sexual and gender-based harassment, stress, and job satisfaction in Sweden
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Police officers encounter challenging and stressful situations at work, which negatively impact their health, job performance, and aspects of their lives. Regarding the gendered structure and competitive work environment of police organizations, women are under extra pressure from the pervasive gendered norms within the police organization. The aim of this dissertation is to study sexual and gender-based harassment and work-related stress as important work environment elements from a gender perspective, and to explore if and how these elements can affect police officers’ job satisfaction in the context of Swedish police work.This thesis is based on three studies: a scoping review, a quantitative study, and a qualitative study, resulting in four articles. In the scoping review study on sexual and gender-based harassment in police work in the European context 16 articles on sexual and gender-based harassment against police employees were studied. Thematic analysis was applied to obtain the main patterns across and within the included studies. In the qualitative study, data collection included one group interview and 12 individual interviews with male and female police officers. Thematic and content analysis were conducted to analyze the interviews. During the quantitative study, data were collected from 152 male and female police officers applying a set of questionnaires including sociodemographic questions, the Police Stress Identification Questionnaire (PSIQ), Sexual and gender-based harassment questions, and Job Descriptive Index (JDI). The scoping review showed that most of the European studies were focused on sexual harassment, while gender-based harassment was often overlooked or mixed with other types of harassment and discrimination. Six main themes were found in the studies; the existence of sexual and gender-based harassment, perpetrators, associated factors, consequences, individual response, and impact of organizational policies. In the mixed methods article, results from the quantitative and qualitative studies on sexual and gender-based harassment indicated that female police officers experienced a statistically significant higher percentage of gender-based harassment compared to male officers. However, there was not any significant gender difference in sexual harassment. “Sexual comments and jokes” and “mocking or telling jokes about the #MeToo campaign” by colleagues were reported as the most frequent sexual harassment and gender-based harassment items. Additionally, police officers identified the presence of toxic jargon and a culture of silence, along with ineffective or negative management styles, as organizational factors that can contribute to the perpetuation of such harassment. Also, the quantitative results on police work stress showed that police officers rated higher on the “impact on significant others” stress and “operational stress” subscales. In addition, female officers reported higher stress in these subscales compared to their male counterparts. The police officers who had experienced sexual harassment reported higher “self-image stress” and “operational stress”. Moreover, in studying job satisfaction among Swedish police officers, both male and female officers reported the highest satisfaction with “people on present job” and the lowest satisfaction with “opportunity for promotion” and then “pay”. No significant gender gap was found in job satisfaction subscales, nor was there a significant association between these subscales and experiences of harassment. However, organizational stress was negatively related to three domains of job satisfaction; “job in general”, “pay” and “supervision”. The research findings revealed that despite substantial changes in the Swedish police organization and work culture during recent decades, the issue of sexual and gender-based harassment remains persistent. This finding highlights the need for more attention to organizational factors (cultural and managerial issues) enabling sexual and gender-based harassment. The findings also underscore the higher levels of work pressure and challenges faced by female officers and the importance of challenging prevailing gender norms affecting both female and male police officers. Moreover, addressing organizational sources of stress can improve the working conditions and job satisfaction of police officers. Finally, the thesis highlights the importance of considering sexual and gender-based harassment along with work stress to create a safer and more productive police work environment.
|
|
| 8. |
- Tetui, Moses, 1983-
(författare)
-
Participatory approaches to strengthening district health managers' capacity : Ugandan and global experiences
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction:Residents of low in-come countries have persistently suffered poor health outcomes, modest progress made over time notwithstanding. Weak health systems are one of the key reasons for the less than optimum progress. These health systems are constrained by inadequately equipped managers who play a main role in curbing this progress. Strengthening the capacity of health managers capacity is one of the known ways to improve the performance of health systems. This study examined strategies for strengthening the capacity of health managers at the sub-national level, with a special focus on the Participatory Action Research (PAR) approach.Methods:I used an emergent qualitative design which included both primary data collection and a literature review. Primary data collection techniques included individual interviews, Focus Group Discussions (FGDs), participant observations, and a review of project documents and meeting minutes, while searching for peer-reviewed databases was used for the literature review. Several analytical tools were adopted to answer the objectives, including the grounded theory, content and thematic analysis approaches. The Critical Interpretive Synthesis (CIS) method was used to analyze the literature reviewed.Findings:Stakeholders’ perceived the approaches to strengthening health managers’ capacity as an overarching process comprised of three interconnected subprocesses namely: the professionalizing of health managers, the use of engaging approaches to learning, and the availability of a supportive work environment. PAR as an engaging approach to learning was experienced by stakeholders as a nuanced awakening approach. On the one hand, stakeholders felt engaged, valued, responsible, awakened and a sense of ownership. On the other hand, they felt conflicted, stressed and uncertain. The PAR approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals, and review progress. Expanded spaces for interaction, the encouragement of flexibility, the empowerment of local managers and the promotion of reflection and accountability enabled this enhancement. Lastly, the literature reviewed revealed five interrelated elements for harnessing PAR to strengthen health managers capacity. These were: a shared purpose, skilled facilitation and social psychological safety, activity integration into organizational procedures, organizational support and supportive external monitoring.Conclusions:Health managers have a central role in strengthening health systems; hence the formalization of their role, especially within the public-sector, is needed. In addition, significant investments into developing and strengthening their capacity is required. Strengthening the capacity of health managers is an iterative process that draws synergies from different approaches. The process leans on formal trainings as well as more engaging means of learning, such as PAR. As an engaging approach to learning, PAR expands interaction spaces, provides inclusiveness and flexibility, promotes local ingenuity and shared responsibility, and allows for monitoring and learning. PAR had positive effects on the strengthening of the capacity of health managers while at the same time achieving other project outcomes. Participatory approaches are hence relevant for dealing with the complex challenges bedevilling health systems. The approach nonetheless should be applied with a more nuanced appreciation of the challenges when using it and the elements for harnessing it to strengthen health systems.
|
|
| 9. |
- Baroudi, Mazen, 1984-
(författare)
-
Leaving the door ajar : young migrants’ sexual and reproductive health in Sweden
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Young people and migrants are both prioritized groups regarding sexual and reproductive health and rights (SRHR), but studies about the sexual andreproductive health (SRH) of young migrants in Sweden are scarce. The aim of this thesis was to study the SRH of young migrants in Sweden, and specifically to: 1) explore how do young migrants understand SRH, and how do they experience their sexual rights; and 2) examine how do young migrants perceive and experience the process of accessing SRH services, including their approachability, acceptability, adequacy and quality.This thesis is built upon three studies, which collected quantitative data (a national survey – Papers 1 and 2, and a youth clinics survey – Paper 3) and qualitative data (a qualitative study – Paper 4). The national survey is a population-based cross sectional study, which recruited 1773 newly arrived young migrants aged 16 to 29 years through visits to schools and other venues, letters sent home, and via a web survey. The data was analysed through descriptive statistics (Paper 1) and multivariate multiple linear regression (Paper 2). The youth clinic survey is a clinic-based cross-sectional study whichrecruited 1089 youths (118 had at least one parent born outside Sweden/Scandinavia) aged 16 to 25 years after their visit to a youth clinic in the four most northern regions in Sweden. I used multi-level analysis to analyse the data. The qualitative study builds upon 13 semi-structured interviews with newly arrived Arabic-speaking migrant men, which were analysed through qualitative thematic analysis.Young migrants understood SRH as both “essential” and a “right”. The sexual rights of young migrants in Sweden were less fulfilled, compared to those of other young people in Sweden, and there were differences between the various groups of young migrants. The rights of men; people identifying as non-binary; people identifying as lesbian, gay, bisexual or asexual (LGBA); those born in South Asia; those without a residence permit; and people of low economic status were fulfilled to a lesser extent compared to their counterparts.Studying the process of accessing SRH services – including sexual education and information, and services related to sexual function, sexually transmitted diseases and gender-based violence, as well as infertility, pregnancy, delivery, contraceptives and abortion – showed barriers and facilitators. SRH serviceswere to a large extent non-approachable; almost half of those who needed these services in the national survey did not use them. SRH services were perceived, with some exceptions, as acceptable due to the “open environment” of Sweden; however, some young migrants faced a lack of cultural sensitivity in iv SRH services, low parental support, and fear of exposure, which decreased their acceptability of the services. Regarding adequacy, young migrants complained about long waiting times for receiving care particularly specialised care, and that SRH services did not take their problems seriously. Those who visited youth clinics, however, perceived them as providing convenient and timely services. The quality of SRH services was perceived as good in general; the majority of young migrants were satisfied with SRH services in the national survey and perceived youth clinics as very friendly. However, negative experiences were reported in the national survey, where almost half of those who visited SRH services had at least one negative experience in the five domains of respect, equity, quality of consultation, privacy and non-prejudice. Migrant youths also reported worse experiences in the youth clinic survey than Swedish/Scandinavian youths in the domains of respect, equity and quality of consultation. Their legal entitlement to access most SRH services, the availability of good quality services and the “open environment” facilitate young migrants’ access to SRH services, however, their limited access to sexual education and to information about the health system, and cultural insensitivity and cultural racism when providing information and services, are serious barriers to young migrants’ access to SRH services.
|
|
| 10. |
- Hansson, Jonas, 1971-
(författare)
-
Mind the blues : Swedish police officers' mental health and forced deportation of unaccompanied refugee children
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Policing is a public health issue. The police often encounter vulnerable populations. Police officers have wide discretionary powers, which could impact on how they support vulnerable populations. In encountering vulnerable populations the police officers are required to be professional; maintaining mental health in the face of challenges is part of professionalism. Their encounters with vulnerable populations might influence their mental health which in turn might influence the way they use their discretion when making decisions.Background/context: Sweden receives more unaccompanied, asylum-seeking refugee children than any other country in Europe. The number of asylum applications for such children increased from 400 in 2004 to 7000 in 2014 to over 35,000 in 2015. These children come to Sweden and apply for asylum without being under the care of their parents or other legal guardian. Some are denied asylum. If they do not return to their country of origin voluntarily the police are responsible for their deportation. The Swedish government wants an increasing number of deportations and wants them carried out with dignity. This thesis is about the police officers’ perceptions of how to interpret the seemingly contradictory demands for more deportations, that is, efficiency; and concerns for human rights during the deportation process, that is, dignity. This is conceptualized using three theoretical frameworks: a) street-level bureaucracy, b) job demand-control-social support model and c) coping. These theoretical frameworks indicate the complexity of the issue and function as constructions by means of which understanding can be brought to the police officers’ perceptions of deportation work involving unaccompanied, asylum-seeking refugee children and how such work is associated to their mental health.Aim: The current research aims to investigate and analyse Swedish police officers’ mental health in the context of deportations of unaccompanied, asylum-seeking refugee children.Methods: This thesis uses both qualitative and quantitative methodology. The qualitative approach comprised interviews conducted to achieve a deeper understanding of the phenomenon of police officers’ perceptions of deportations of unaccompanied, asylum-seeking refugee children. The quantitative method involved the use of validated questionnaires to investigate the association between police officers’ mental health and psychosocial job characteristics and coping. This approach made it possible to study a complex issue in a complex environment and to present relevant recommendations. A total of 14 border police officers were interviewed and 714 police officers responded to a survey.Results: The police officers utilize their wide discretionary powers and perceive that they are doing what is best in the situation, trying to listen to the child and to be aware of the child’s needs. Police officers with experience of deportations of unaccompanied, asylum-seeking refugee children were not found to have poorer mental health than police officers with no such experience. Furthermore, high job demand, low decision latitude, low levels of work-related social support, shift work and being single are associated with poor mental health. Coping moderates the association between mental health and the experience of carrying out deportations of unaccompanied, asylum-seeking, refugee children, and the police officers seem to utilize both emotional and problem-solving coping during the same complex deportation process.Implications / conclusions: The general conclusion reached in this thesis is that if police officers are subject to reasonable demands, have high decision latitude, access to work-related social support, and utilize adaptable coping, the deportation work does not seem to affect their mental health. When police officers meet vulnerable people, they utilize their discretionary powers to deal with seemingly contradictory demands, that is, efficiency and dignity. The executive role in the deportations of unaccompanied, asylum-seeking refugee children and the awareness of dealing with a child threatened with deportation might give rise to activation of a sense of protection, safety and security. Discretion might make it possible to act on this sense of protection, safety and security and to combine efficiency and dignity. Further studies, which integrate cognitive and emotional discretion with coping, need to be undertaken.
|
|
